ADs and pregnancy

[Midge25]

Have a history of depression and anxiety and have had periods of treatment of varying durations over the last 12 years or so. Last 2 episodes have been more anxiety than depression related, iykwim. Treatment has been with SSRIs which have been brilliant: I've had both fluoxetine and Citalopram in the past. Have also had counselling which was less successful. Am currently prescribed C'pram after an episode that began in early spring - both GP and I had concluded that this might need to be a long term plan as episodes are getting closer and closer together. Problem is that I've also been hoping for a long time to have another dc. Have put it off for last 2 years for practical reasons and dd is now nearly 5. I'm 33. GP feels that there may be fertility issues if I wait, and there are other issues linked with DH's work and poss changes to accommodation which make now the 'right time', but GP not happy for me to continue on C'pram. At the moment I'm reducing dose but am already feeling anxiety symptoms creeping back. Feel like my mh is trapping me... GP has suggested trying older tricyclics which are 'safer' if I do fall pg, and I'm wondering whether to try and tough it out over course of pg and maybe try counselling again: am very worried about side effects of tricyclics. Does anyone in the know have words of wisdom/experience?

[sillymummy11]

I've only tried one tricyclic (was on it for about 6 years) and the side effects were actually not as bad as SSRI's. But then I was told to go on SSRI's after having a baby as they were 'safer' for breastfeeding. I thought the main problem with tricyclics is that they are more toxic if you take too many rather than the side effects...or are you worried about possible effects on the baby?

[Midge25]

Hi sillymummy thanks for replying. I think it's a bit of both really... Have been spending a bit too much time on Dr Google iykwim! Did you find the tricyclics as effective as SSRIs?

[Hoophopes]

Hi - I was told SSRI's, particularly sertraline was safe in pregnancy. I know I was also offered citalopram at a lowish dose also, so interesting what your gp says. You could get your gp to contact a perinatal psychiatrist, or just a psychiatrist, to find out what medication is best - I saw a psychiatrist for medication changes (was on medication that I had to come off when found out I was pregnant) which was helpful. hope it all goes well.

I put off for many reasons, MH being one of them and had my ds at 37. In the end I decided doing it on medication was best for me and I have a healthy baby. The issue with more modern medication is not that they are less safe, there is less evidence or years of data.

[Midge25]

Thank you hoophopes. I struggled through my last pregnancy depressed, anxious and with thoughts of suicide because I felt I couldn't be on ADs. As was already so anxious I didn't want to add them into the mix as I felt it would be an extra thing for me to be fearful of, if that makes sense. I kept the 'mask' up for professionals as one does.

At the moment the thought of a similar pregnancy fills me with dread-it really affected my bond last time and I didnt feel like 'a mummy' for a long time. I like the idea of my GP contacting a perinatal psych and may suggest that

[Midge25]

I think the extra dimension to this is that my anxiety naturally prompts me to be worried about taking meds in pregnancy-yet the anxiety itself is part of the issue, if that makes sense

[Hoophopes]

Midge - totally understand about keeping the mask up. In the end I asked to be referred to the mental health midwife at our hospital, saw her once (got a tour of hospital which you can't have where I am now - only video tour) and she saw me in hospital after birth. Just took bit of stress out for me. Could you ask for that if your area has one? My normal midwife (and health visitor ) were useless, are useless so I felt the need for bit more support in case I had major wobble in labour!!

But many people take SSRI's in pregnancy - so getting gp to find out more (which is what I did in the end) is helpful. Know there are SSRI's for breastfeeding. I was told that it was important to look after me so that I could look after baby. I found the free baby massage class at my local sure start centre really helpful for bonding with my baby also - but would recommend booking asap after birth as I had to wait 4 months!!

Could your gp refer you for CBT to help with anxiety if you not already had it? If pregnant you not meant to wait long - and it is a short course.

[sillymummy11]

Midge- I got on better with the tricylics than the SSRI's to be honest. But maybe that's just me.

Hoophopes is right about MH midwife/psychiatrist. I was referred to the mother and baby unit whilst pregnant with no 3 (after having PND crisis with no 2) and the psychiatrist was brilliant in giving me all the info I needed about meds, pros and cons, effects of stress on babies. It was really, really helpful. As hoophopes says, ask your GP.

Best of luck!

[Hoophopes]

That is good to hear sillymummy11. If you go to your Gp you don't necessarily have to see the MH psychiatrist to find out about medication - as it was my first pregnancy the MH mother and baby unit didn't want to see me, as where I am it is separate from the MH midwife that works at the hospital - but that suited me as I saw who I needed to for reassurance and the dr got the information about pregnancy and medication.

[Hoophopes]

Hope gp helpful for you and it all goes ok x

[Midge25]

Thank you to you both-v helpful. Have GP appt next week and will pop back to update

[cupcake78]

I have just been through this exact situation. Was on fluoxetine been to gp regarding pregnancy and ADs. After much misinformation my GP found the official research and advice for fluoxetine and sertraline in pregnancy. I read it and basically it said risk factors are minimal, some babies have had problems but this cant be definitely associated to the drugs and could just be down to chance. risk of withdrawal for 1st 24hrs for baby but no lasting effects and doesnt affect all babies. She also said she had people fall pregnant on these drugs on a weekly basis and the babies have been healthy.

She contacted a pregnancy psychiatrist for advice and I was told the psychiatrist would recommend sertraline simply because it gave me the option the breast feed which fluoxetine didn't. It was in her option the best AD for pregnancy.

I have switched to sertraline and have been given the go ahead to get pregnant! We are now ttc . Good luck

[somewherebecomingrain]

Hey cupcake think we
Met on another thread. Howdy! This is a good thread. The maternal mh people at mu hosp told me sertrLine is fine and they've actually never seen any of the reported problems - that's a bit anecdotal I know but that's what they said.

Op I'm 40 and 12w pg with dc 2 - had exactly the same dilemma as you. Dreading it but knowing I didn't have all the time in the world. 33 is nothing unless u have a history of fertility probs. hope that's reassuring.

I'm desperate to go on some meds cause I'm the breadwinner, I'm freelance and no slacking or time off sick is poss, and I have work-related PTSD from bullying 7 years ago. I don't think I've ever stated it as clearly as that! My meds do keep it at bay but now I'm struggling with fear and low self esteem. It's v specific. I do have other probs like arguing with partner shouting at ds being disorganised but it's the work
Stuff that crucified me.

[Midge25]

Thanks again all. Interesting to hear about sertraline. Am making notes to take to GP on Tues

[Midge25]

Saw GP... She feels there's 'time' prior to TTC to get anxiety sorted. Am back up to 20mg Citalopram and feel so much better. GP has also referred me for CBT to hopefully learn some management techniques that I can use when off the meds

[thingamajig]

Hi, I have been through two pregnancies on citalopram 60mg. My babies are absolutely fine; dd1 had some wobbles and a week in SCBU, but not necessarily related to the tablets. The twins were fine, and I was also on Lithium for them. I BFed for a year each time.
Do not accept what your GP says - he is wrong. Suggestions about him asking maternal psych are good, also he (or you) can ask your local hospital pharmacist for the latest research - call the switchboard and ask to be put through. If you need the tablets and are well on them, take them. Depression and anxiety are not good for pregnancy either. If it is the right time for you to start trying, then do it.